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1295891091 NPI number — PEDIATRIC PHYSICAL THERAPY ON THE MOVE, PA

NPI Number: 1295891091
Health Care Provider/Practitioner: PEDIATRIC PHYSICAL THERAPY ON THE MOVE, PA

Information about “1295891091” NPI (PEDIATRIC PHYSICAL THERAPY ON THE MOVE, PA) exists in 1295891091 in HTML format HTML  |  1295891091 in plain Text format TXT  |  1295891091 in PDF (Portable Document Format) PDF  |  1295891091 in an XML format XML  formats.

NPI Number : 1295891091 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1295891091",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "PEDIATRIC PHYSICAL THERAPY ON THE MOVE, PA",
    "LastName": null,
    "FirstName": null,
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "16322 SW 14TH ST",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "PEMBROKE PINES",
    "MailingAddressStateName": "FL",
    "MailingAddressPostalCode": "33027-5121",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "954-383-4239",
    "MailingAddressFaxNumber": "954-435-2810",
    "FirstLinePracticeLocationAddress": "55 WESTON RD",
    "SecondLinePracticeLocationAddress": "SUITE #103",
    "PracticeLocationAddressCityName": "WESTON",
    "PracticeLocationAddressStateName": "FL",
    "PracticeLocationAddressPostalCode": "33326-1169",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "954-383-4239",
    "PracticeLocationAddressFaxNumber": "954-435-2810",
    "EnumerationDate": "12/28/2006",
    "LastUpdateDate": "09/11/2025",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "CUELI-DUTIL",
    "AuthorizedOfficialFirstName": "TRACY",
    "AuthorizedOfficialMiddleName": "C.",
    "AuthorizedOfficialTitle": "PRESIDENT",
    "AuthorizedOfficialNamePrefix": "DR.",
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": "DPT",
    "AuthorizedOfficialTelephoneNumber": "954-383-4239",
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "2251P0200X",
          "TaxonomyName": "Pediatric Physical Therapist",
          "LicenseNumber": "PT17075",
          "LicenseNumberStateCode": "FL",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "2251N0400X",
          "TaxonomyName": "Neurology Physical Therapist",
          "LicenseNumber": "PT17075",
          "LicenseNumberStateCode": "FL",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": {
      "HealthcareProviderTaxonomyGroup": [
        {
          "HealthcareProviderTaxonomyGroupName": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
          "HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
        },
        {
          "HealthcareProviderTaxonomyGroupName": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
          "HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
        }
      ]
    }
  }
}
                
            

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